Indications for viscosupplementation?

[Louisville04]

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I know viscosupplementation is indicated for osteoarthritis of the knee. Is it also indicated for chondromalacia of the knee? Working in the VA, I have seen some orthopods give viscosupplementation for this diagnosis. Would this be allowed in the private sector?

 

[deleted185747]

Hyaluronic acid is anti-inflammatory, so it may help with chondromalacia which is inflammatory in nature.

Just my 2 cents

 

[PMR 4 MSK]

Visible chondromalacia, such as that seen on MRI, is a form of OA, so it would be indicated. For a teenager with the same condition, no.

The bigger question is will it help? That has not been researched, to my knowledge.

 

[Louisville04]

When you inject knees, do you numb up the skin with lidocaine, freeze spray, or nothing? What gauge needle do you use? 18?

 

[Gauss]

freeze may be enough, some will not tolerate and will need lido. If you only freeze them go with 25g, if lido 22g.

 

[RUOkie]

I usually use nothing, although I offer lido. Most of my patients just say, one shot is enough.

 

[lobelsteve]

100% now with fluoro and air contrast.

27g to numb the skin and into the joint.
22G 2" to access the joint.

AP/Lat Fluoro after 5-10cc air to confirm in the capsule.

Then inject and clear catheter with lido.

 

[Gauss]

I use same needles as Steve. No fluoro just US for suprapatellar joint space confirmation. However, many insurances are starting to deny US code so I don't know how Steve gets fluoro covered.

 

[deleted185747]

I have done over 1000 hyalgan knee injections and this is what I do based on refinement of technique and feedback from patients:

25 ga 1.5 inch needle

First have patient lie supine with knee extended. If patella is mobile then proceed with superiolateral approach. Studies show that superiolateral approach is intra-articular 95% of the time. I prep then press on my needle entry site thru an alcohol prep pad with my thumb-hard- for about 20 seconds then enter the skin with the needle and proceed with injection (75-100% of the needle is in). After doing a lot of these you will have a feel of high or low resistance thru the 25 ga needle. If high resistance then redirect. If the injection ever hurts you are not in the joint and need to reposition.

If the patella is not mobile sit pt up with knee flexed 90 degrees and use anteriolateral approach. Studies show that your needle is intra-articular 73% of the time using this approach. Again, if the injection causes pain you are not in the joint. I use my thumb to apply pressure for 20 seconds over the entry site (I tell patients its a pressure point technique and they tell me it works great).